Best enlarged Prostate treatment

[outofafrica]

There are many treatments and surgery available for enlarge prostate which ones are the most effective .Also how soon should one have this done when symptoms start.

[geriatrickid]

Every patient is unique. This is because  each patient presents with specific underlying medical conditions and characteristics of enlargement.  An enlargement might be similar in two patients, but the treatment very different. An aggressive  surgical approach is not appropriate for elderly frail patients. A surgical method which has a higher rate of success, but a greater likelihood of impotence adverse reaction  may be  worth  considering in a 70 year old who doesn't have much need for intercourse. It is most likely inappropriate for a  50 year old with a robust sex life.  A chemotherapy regimen which might  be appropriate for an otherwise healthy patient could kill a patient with heart disease and a history of MI.

 

In the absence of a complete medical history and lifestyle review, there is absolutely no point in asking for  the  "best" treatment approach because there isn't  one treatment that is best for everyone. The best approach  is to find a competent urologist with experience in treating the condition. Ideally, the specialist should be affiliated with a teaching hospital so that the most update to date procedures available are accessible.

[gk10002000]

Simple method number 1 is to lose weight.  You would be surprised how much fat is inside you and around your organs.

[outofafrica]

More information about myself.I'm not fat and cycle to and fron work about 150 / week and more when i'm fitter. I'm 58 years old.I't started with a UTI .I was placed on antibiotics but it was the wrong one and the infection moved to my kidneys. I landed up in hospital and they gave me the correct antibiotics.The Kidney infection was gone within a day. So i stayed on the mencation for 10 day's .As soon i i finished that the infection was back so they put me on another general antibiotic.They also did a scan ,blood test and internal examination and said that my prostate is enlarged but normal for my age. My water flow has improved and i'm off the antibiotics for two days. After 5 days of completing the antibiotics i will go for another Urine test. The also did bladder measurment and i am border line retaining urine after a wee.

 

[Sheryl]

Losing weight will not hep an enlarged prostate, though  if the person is overweight to start with it will have many other health benefits.

 

As other poster said, there is no one "best" treatment.  Each case is different. There is no substitute for the care of a good urologist.

 

Need to differentiate between benign prostatic hypertrophy (BPH) and prostate cancers. And even for each of these, there are different treatment options. For BPH, medication is always the first approach, and there are several drugs that can be tried.  Only if medical therapy fails and the problem is svere, is surgery considered.

 

[thequietman]

10 minutes ago, outofafrica said:

More information about myself.I'm not fat and cycle to and fron work about 150 / week and more when i'm fitter. I'm 58 years old.I't started with a UTI .I was placed on antibiotics but it was the wrong one and the infection moved to my kidneys. I landed up in hospital and they gave me the correct antibiotics.The Kidney infection was gone within a day. So i stayed on the mencation for 10 day's .As soon i i finished that the infection was back so they put me on another general antibiotic.They also did a scan ,blood test and internal examination and said that my prostate is enlarged but normal for my age. My water flow has improved and i'm off the antibiotics for two days. After 5 days of completing the antibiotics i will go for another Urine test. The also did bladder measurment and i am border line retaining urine after a wee.

 

Riding a bicycle everyday would not be helping the prostate, especially on these roads. My urologist suggested constant pressure on the area from the bicycle seat may be causing the enlargement. Maybe look at that.

[outofafrica]

Just now, thequietman said:

Riding a bicycle everyday would not be helping the prostate, especially on these roads. My urologist suggested constant pressure on the area from the bicycle seat may be causing the enlargement. Maybe look at that.

Thanks ,i did and bought a seat designed to stop pressure on the prostate!!

 

[Sheryl]

1 hour ago, outofafrica said:

More information about myself.I'm not fat and cycle to and fron work about 150 / week and more when i'm fitter. I'm 58 years old.I't started with a UTI .I was placed on antibiotics but it was the wrong one and the infection moved to my kidneys. I landed up in hospital and they gave me the correct antibiotics.The Kidney infection was gone within a day. So i stayed on the mencation for 10 day's .As soon i i finished that the infection was back so they put me on another general antibiotic.They also did a scan ,blood test and internal examination and said that my prostate is enlarged but normal for my age. My water flow has improved and i'm off the antibiotics for two days. After 5 days of completing the antibiotics i will go for another Urine test. The also did bladder measurment and i am border line retaining urine after a wee.

 

 

It sounds like the enlarged prostate per se may not need treatment at this stage.  There is likely some edema in the bladder which is contributing to the difficulty with urination in which case it may improve on its own.  I suggest you continue with the treatment you are getting, it sounds like the doctors are on top of it.

[nong38]

I cycle a fair bit and h am having a few prostrate issues, my seat is about on its last legs and needs replacing so what sort of seat should I look for that would be "prostrate friendly"?

[colinneil]

7 minutes ago, nong38 said:

I cycle a fair bit and h am having a few prostrate issues, my seat is about on its last legs and needs replacing so what sort of seat should I look for that would be "prostrate friendly"?

 

7 minutes ago, nong38 said:

 

 

Buy a mobility scooter.

Edited June 18, 2017 by colinneil

[TallGuyJohninBKK]

52 minutes ago, nong38 said:

I cycle a fair bit and h am having a few prostrate issues, my seat is about on its last legs and needs replacing so what sort of seat should I look for that would be "prostrate friendly"?

 

This is not a medical opinion....but I remember reading about this issue re cycling a long time back when I was really bicycling a lot.

 

So I ended up getting a seat for my bicycle that basically is normal on the right and left sides to support your bum cheeks, but then is basically open for the segment running down the middle front to back, so it's not putting any pressure on the genital area. Never had any problems using it thus far.

 

BTW, on the broader subject, it's been my impression over time that there seems to be a fair amount of over and unnecessary diagnostic and treatment activity relating to prostate issues, especially in older men say 70 and above. But I'll note the OP here indicates he's not yet at that older age range.

 

From a 2014 report by the BBC:

 

Quote

 

Current best practice, at centres like Addenbrookes in Cambridge - where the study was carried out - and University College London Hospitals, is for patients to have an initial MRI scan.
This can often rule out any abnormality in the prostate meaning there is no need for any invasive tests.

If a biopsy is required, the MRI scan is used as a template to accurately guide where to place the needle.

Professor Mark Emberton a consultant urologist at UCLH said in no other cancer would specialists take 'blind samples' of tissue, and there was now no need for it in prostate cancer.

He said diagnostic accuracy using MRI targeted biopsies was now in excess of 95 per cent, so men should be confident that they would get the best treatment.

Guidelines on prostate cancer treatment in England commissioned by NICE revealed that around three quarters of cancer specialists now use MRI for the detection of prostate cancer.

 

http://www.bbc.com/news/health-26996785

 

 

Edited June 18, 2017 by TallGuyJohninBKK

[tifino]

2 minutes ago, TallGuyJohninBKK said:

 

This is not a medical opinion....but I remember reading about this issue re cycling a long time back when I was really bicycling a lot.

 

So I ended up getting a seat for my bicycle that basically is normal on the right and left sides to support your bum cheeks, but then is basically open for the segment running down the middle front to back, so it's not putting any pressure on the genital area. Never had any problems using it thus far.

 

 

 

... and there are a few styles about these days... 

 

attached       https://www.google.com.au/search?q=easyseat&safe=off&source=lnms&tbm=isch&sa=X&ved=0ahUKEwiz8tn8pMfUAhVD8WMKHdlAAdYQ_AUICygC&biw=1366&bih=662#imgrc=_jF7HPLapbfTQM:

 

I have been a n 'EastSeat' user since 1988. I now have 4 of them; on 2 MTBs, my recumbent 2 wheeler, and recumbent trike

 

The dread of having a future condition of squashed pipeworks in the groin have I hope been averted early enough in my life  with thanks to these units

 

 

Considering the type of traffic a falang has to encounter around LOS;

the other good factor about this style of seating is that when you do eventually get hit by a motorcycle,

the EasySeat (as in my case, years back) enabled me to be thrown clear of my treddlie, when we parted ways in our different trajectories

 

The accident took me out big time regarding mucscular skelatel problems, for the back, neck, shoulder and a knee...

... but the family jewels were unaffected (thank you EasySeat)

 

the one and only negative about these 'spineless' seats, is that they are heavier, much heavier, than your conventional ball-crushers

[TallGuyJohninBKK]

For the OP's interest, here's the website of a 2012 U.S. medical task force finding on prostate issues that recommends against the use of PSA-based screening for prostate cancer. The prior recommendation in 2008 had advised against it for older men, but the 2012 finding expanded that recommendation that it be avoided for all age groups.

 

There's a lot of information in their report relating to prostate cancer issues, issues of diagnosis and treatment, and how the medical community in the past has often overdone things in this area.

 

https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/prostate-cancer-screening#Pod1

 

Quote

Contemporary recommendations for prostate cancer screening all incorporate the measurement of serum PSA levels; other methods of detection, such as digital rectal examination or ultrasonography, may be included. There is convincing evidence that PSA-based screening programs result in the detection of many cases of asymptomatic prostate cancer. There is also convincing evidence that a substantial percentage of men who have asymptomatic cancer detected by PSA screening have a tumor that either will not progress or will progress so slowly that it would have remained asymptomatic for the man's lifetime. The terms "overdiagnosis" or "pseudo-disease" are used to describe both situations. The rate of overdiagnosis of prostate cancer increases as the number of men subjected to biopsy increases. The number of cancer cases that could be detected in a screened population is large; a single study in which men eligible for PSA screening had biopsy regardless of PSA level detected cancer in nearly 25% of men.² The rate of overdiagnosis also depends on life expectancy at the time of diagnosis. A cancer diagnosis in men with shorter life expectancies because of chronic diseases or age is much more likely to be overdiagnosis. The precise magnitude of overdiagnosis associated with any screening and treatment program is difficult to determine, but estimates from the 2 largest trials suggest overdiagnosis rates of 17% to 50% for prostate cancer screening.³

 

Quote

 

There is convincing evidence that PSA-based screening leads to substantial overdiagnosis of prostate tumors. The amount of overdiagnosis of prostate cancer is of important concern because a man with cancer that would remain asymptomatic for the remainder of his life cannot benefit from screening or treatment. There is a high propensity for physicians and patients to elect to treat most cases of screen-detected cancer, given our current inability to distinguish tumors that will remain indolent from those destined to be lethal.^{7, 11} Thus, many men are being subjected to the harms of treatment of prostate cancer that will never become symptomatic. Even for men whose screen-detected cancer would otherwise have been later identified without screening, most experience the same outcome and are, therefore, subjected to the harms of treatment for a much longer period of time.^{12, 13} There is convincing evidence that PSA-based screening for prostate cancer results in considerable overtreatment and its associated harms.

The USPSTF considered the magnitude of these treatment-associated harms to be at least moderate.

 

 

Quote

 

Burden of Disease

An estimated 240,890 U.S. men received a prostate cancer diagnosis in 2011, and an estimated 33,720 men died of the disease.³⁵ The average age of diagnosis was 67 years and the median age of those who died of prostate cancer from 2003 through 2007 was 80 years; 71% of deaths occurred in men older than 75 years.¹ Black men have a substantially higher prostate cancer incidence rate than white men (232 vs. 146 cases per 100,000 men) and more than twice the prostate cancer mortality rate (56 vs. 24 deaths per 100,000 men, respectively).³⁵

Prostate cancer is a clinically heterogeneous disease. Autopsy studies have shown that approximately one third of men aged 40 to 60 years have histologically evident prostate cancer³⁶; the proportion increases to as high as three fourths in men older than 85 years.³⁷ Most cases represent microscopic, well-differentiated lesions that are unlikely to be of clinical importance. Increased frequency of PSA testing, a lower threshold for biopsy, and an increase in the number of core biopsies obtained all increase the detection of lesions that are unlikely to be of clinical significance.

 

 

Quote

 

The U.S. Preventive Services Task Force (USPSTF) recommends against prostate-specific antigen (PSA)–based screening for prostate cancer.

 

This recommendation replaces the 2008 recommendation.³⁸ Whereas the USPSTF previously recommended against PSA-based screening for prostate cancer in men aged 75 years and older and concluded that the evidence was insufficient to make a recommendation in younger men, the USPSTF now recommends against PSA-based screening for prostate cancer in all age groups.

 

 

Edited June 18, 2017 by TallGuyJohninBKK

[Sheryl]

The OP is not suspected of having prostate cancer. 

 

 

He has only mild prostate enlargement typical of a man his age, nothing more. Some trouble with urinary retention that is more likley due to edema (swelling) of the bladder neck due to the UTI he is being treated for.

[nong38]

Last checked out in the UK, no problem normal reading and the same in Thailand in January but aware that things are changing so thanks for the input will have a look at th easyseat at my bike shop.

[TallGuyJohninBKK]

24 minutes ago, Sheryl said:

The OP is not suspected of having prostate cancer. 

 

 

He has only mild prostate enlargement typical of a man his age, nothing more. Some trouble with urinary retention that is more likley due to edema (swelling) of the bladder neck due to the UTI he is being treated for.

 

Thanks Sheryl. I was aware of that from his posts above. The point of my post was simply to alert the OP and others that once men go in and start seeing doctors about prostate issues, there are some broader issues about how the medical community has over-relied on PSA tests and misdiagnosed and overtreated as a result of them in the past. Just something to be aware of as an informed medical consumer.

 

I guess it's also a personal issue for me, because my elderly father in his late 70s had elevated PSA tests, was sent for biopsies, told he had prostate cancer by his treating doctor (and that was very hard on my father psychologically), and then subjected to additional biopsies over an extended period of time -- all before another specialist finally told him that whatever he had, it wasn't going to do him any harm and he surely would die of something else long before anything related to his prostate.

 

Edited June 18, 2017 by TallGuyJohninBKK

[tifino]

and here I am, thinking life is so simple,

 

when one can get by with:

 -  having my Dr's finger up my clacker for the PrEnlargement test, and

 -  the BloodTest for PrCancer

[teddog]

You will know when its operation time, when every drug, every bit of endless information falls by the wayside .. not pissing when you want /pissing when don't want to, wearing dark coloured clothing, changing your pants 2 or 3 times a day.

 

  Probably the kindest thing the surgeon said to me as I woke up after the op a few months ago was ' life must have been most unpleasant for you'

[al007]

I have quite a lot of experience of Prostate problems, I have had holep surgery in India and was also diagnosed with Prostate and Colorectal cancer, about 9 mths ago

 

I have posted extensively in the past and do not propose to repeat what I have already said

 

Today and just for today I am doing well

 

I am always happy to talk on the phone with anyone who has prostate related problems, and if applicable PM me and I will send my phone number

 

Keep smiling , stay happy, this in itself helps healing

[muskoka]

interesting article, no opinion.

 

Quote

Why I Won't Get a PSA Test for Prostate Cancer

https://blogs.scientificamerican.com/cross-check/why-i-wont-get-a-psa-test-for-prostate-cancer/

[Sheryl]

I personally think the problem is not the test but unwise use of the results, going overboard in reacting to an elevated reading.

 

A lot of the problem comes from the medico-legal culture in the west, doctors are so fearful of being sued that they will always err on the side of unnecessary investigations when there is anything that might possibly indicate cancer. Likewise patients tend to be easily spooked by the "C" word.  A doctor is far more likely to be blamed (or, in the west sued) for failing to investigate a lab result that is potentially indicative of cancer than he is of doing unnecessary tests.

 

PSA has its place, especially among symptomatic men (but can also be useful to have a baseline reading every now and then after say age 50) as long as it is used judiciously. It will be elevated in benign prostate enlargement but it will not usually be astronomically so, nor will it shoot up rapidly in benign conditions other than acute prostatitis. So it can be helpful as one of several paramenters in deciding whether or not further investigations are warranted.

 

It can also help distinguish fast growing from slow growing tumors, which is an important consideration in elderly men, as slow growing ones may be best left untreated.

 

What you are reading now is a reaction to a past tendency to do mass PSA screening and leap to biopsy for elevated results, which was misguided. However as with any wrong approach there is a risk of going to far to the opposite extreme.

 

 

[al007]

2 hours ago, muskoka said:

interesting article, no opinion.

 

https://blogs.scientificamerican.com/cross-check/why-i-wont-get-a-psa-test-for-prostate-cancer/

Stupidity

 

PSA test is done from blood sample, and non invasive

At least establish a base level

This basic test has flagged many people to look further, and IT CAN POINT TO CANCER RISK

It is not expensive please anyone give a good reason not to have it

 

In my case it is primarily used to monitor if my prostate cancer might be returning or spreading, and gives reassurance, one of many tests I have

Edited June 19, 2017 by al007

[Sheryl]

As above, there is no reason not to have it provided the patient and the doctor understand its limitations and make intelligent, informed  use of the results.

 

People who are inclined to be over- anxious about their health might do better to stay away from this and other types of "cancer marker" tests unless there are clear clinical indications for it, as that type of person will often be incapable of taking a "wait and see" approach to an elevated reading no matter what the doctor tells them.   And urologists who are not up to date in their field, experienced and with a high level of clinical skill, are best avoided, period.

 

In the hands of  really skilled doctor and informed, not overanxious, patient, the test is fine.

[tartempion]

Over the last 20 years I had chronic prostate infections followed by BPH.
Twice year have PSA checked. Went up to 17 at some point in time.
Had it stabilized around 7 for some years.
Tried many meds.
Since over a year am on combodart, two last PSA checks 4.x
Go for a pee around 2am.
Not complaining, my age 71.


Sent from my iPad using Thaivisa Connect

[Agusts]

How about MRI,  it's far better and more accurate, it can even help to a better , more guided biopsy, highly recommended now over just PSA ....check it out. 

[TallGuyJohninBKK]

33 minutes ago, Agusts said:

How about MRI,  it's far better and more accurate, it can even help to a better , more guided biopsy, highly recommended now over just PSA ....check it out. 

 

If you look back to my post #11 in this thread and the 2014 BBC report I excerpted there, that's exactly what they were saying:

 

Quote

Guidelines on prostate cancer treatment in England commissioned by NICE revealed that around three quarters of cancer specialists now use MRI for the detection of prostate cancer.

 

The one issue I can think about that is, an MRI is a much more expensive test than a PSA test. So I can see doing an MRI if there's some indication of a prostate problem. But just to do one as a screening technique absent any symptoms, that I'm not sure about.

 

I thought Sheryl did a good job in her couple of prior posts in this thread in laying out the current, best practice thinking on this issue, and that's that there's nothing inherently wrong with a PSA test, although it can have a fair rate of false results. But the main problems come in when either patients or doctors take the PSA results alone and start running off to the races with potentially unwarranted biopsies and surgeries and such....

 

[nontabury]

On June 18, 2017 at 10:16 AM, geriatrickid said:

Every patient is unique. This is because  each patient presents with specific underlying medical conditions and characteristics of enlargement.  An enlargement might be similar in two patients, but the treatment very different. An aggressive  surgical approach is not appropriate for elderly frail patients. A surgical method which has a higher rate of success, but a greater likelihood of impotence adverse reaction  may be  worth  considering in a 70 year old who doesn't have much need for intercourse. It is most likely inappropriate for a  50 year old with a robust sex life.  A chemotherapy regimen which might  be appropriate for an otherwise healthy patient could kill a patient with heart disease and a history of MI.

 

In the absence of a complete medical history and lifestyle review, there is absolutely no point in asking for  the  "best" treatment approach because there isn't  one treatment that is best for everyone. The best approach  is to find a competent urologist with experience in treating the condition. Ideally, the specialist should be affiliated with a teaching hospital so that the most update to date procedures available are accessible.

I don't know where you get the idea, that a 70yr old doesn't have need for intercourse. some 70yr olds can still perform daily,even without the need for any medicine. Could possible also apply to 80yr old.

 

 Regarding bycycle seats. I go out about 3-4 a week, cycling anywhere between 16-25 k each time. Use a seat with the center part missing.therefore just supported on my cheeks. No problem,although I do worry about the other road users.

[al007]

4 hours ago, nontabury said:

I don't know where you get the idea, that a 70yr old doesn't have need for intercourse. some 70yr olds can still perform daily,even without the need for any medicine. Could possible also apply to 80yr old.

 

Despite Chemo, Radiation treatment, and Holep,for Prostate, I can still very much enjoy sex, this was one of my greatest fears of all this at 72 plus 3 mths, can still orgasm very strongly but after the Holep surgery most of the ejaculation stays inside, but sensations just as strong

 

 Be married and happily , as such I can only report hearsay ! !! I have heard has has added benefit some females think nothing has happened so work even harder to satisfy the man

[teddog]

3 hours ago, al007 said:

Despite Chemo, Radiation treatment, and Holep,for Prostate, I can still very much enjoy sex, this was one of my greatest fears of all this at 72 plus 3 mths, can still orgasm very strongly but after the Holep surgery most of the ejaculation stays inside, but sensations just as strong

 

 Be married and happily , as such I can only report hearsay ! !! I have heard has has added benefit some females think nothing has happened so work even harder to satisfy the man

 

 

5

5

Ill say,'no cum no pay' is a slogan, they do too.  now 3 months after op, still get the urge but less so,  ,was bloody rabid before but now joined the ranks of most other guys can say  no,more rested,feel fresher and happier and of course wealthier.  doc explained not always dry run but did emphasise 13 months was needed to ascertain firing blanks

Edited June 20, 2017 by teddog

[outofafrica]

On 6/18/2017 at 3:10 PM, Sheryl said:

 

It sounds like the enlarged prostate per se may not need treatment at this stage.  There is likely some edema in the bladder which is contributing to the difficulty with urination in which case it may improve on its own.  I suggest you continue with the treatment you are getting, it sounds like the doctors are on top of it.

Yeah you right. It was only a UTI and after three different Antibiotics and twice in hospital on intravenous antibiotics it has cleared up but i now have a problem with  C. difficile. I have been through hell ,but at last the did a stool test and confirm some more antibiotics to kill this one.